Pain and Addiction Management – Drug Testing

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Many substances that are prescribed for pain management and other
legitimate indications are found to be taken incorrectly (either inadvertently or purposefully),
shared, sold, or otherwise misdirected. In addition, many substances are available for illicit
use, including prescription substances (eg, opioids, Adderall, Xanax) and/or nonprescription
drugs (eg, heroin, methamphetamines).

To ensure safe and effective therapy, current practice guidelines
recommend monitoring patients for adherence to prescribed medication(s) and abstinence from
nonprescribed drugs through periodic drug tests. 1 However, drug testing strategies and testing
methods are not standardized, adding challenges to the selection of the right test, collection
of the appropriate specimen, and interpretation of test results.

Specimens

Urine and blood specimen (serum/plasma) tests are available for most drugs
commonly prescribed for pain management, as well as many illicit substances. Urine is typically
preferred for pain management testing; serum or plasma is an acceptable alternative.

Saliva testing is available for select drugs; however, there is no evidence
that drug testing in alternate specimens (eg, hair, saliva) is more effective than urine testing
in pain management patients.

Timing of Collection

Specimens should be collected for drug testing at the initiation of opioid
therapy and periodically during therapy to confirm the presence of prescribed medications and
exclude the presence of illicit and nonprescribed drugs.